Informaticopia

Friday, September 17, 2010

Wednesday, September 15, 2010

Medinfo Day 3

The first session I got to on the third full day of the conference, was the nursing informatics (NI) session. As I walked in (a couple of minutes late) a picture of Florence Nightingale was on the screen & I wondered how much we had moved on? Heimar Marin gave a history and overview of IMIA’s WG 8 Nursing Informatics Specialist Interest Group. She called for more countries to join. Panellists spoke about developments in their own areas of the world. Hyeoun-Ae Park described Korea, Japan and Taiwan including their population, life expectancy and health care systems along with the development of NI and their use of ICT in the country. She described the education of nurses in Korea country and how the use of ICT had developed over the last 20 years, until its current state “Ubiquitous healthcare” which uses telemedicine and telecare approaches. She also presented, on behalf of others, the situation in Japan which is now moving from a vocation based system towards a more science based system. In a similar way to Korea and Japan the use of technology is moving from educational to clinical uses with standardised languages as part of the EHR. Taiwan will be hosting the NI conference in 2015.

Patrick Weber spoke for Europe on current practice and education. He plugged a recent book and then moved on to look at EU approaches to IT underpinning strategic policy in eHealth to promote empowerment of the individual via electronic systems. He used the developments in Switzerland to illustrate national approaches before looking at them likely effects of demographic change and the increase in chronic diseases in Europe. The next speaker was Sue Newbold from the USA who talked about the NI history group which is hosted by AMIA on their web site. Interviews with various pioneers in the field have been recorded and transcribed. These are made available on the web site and Sue showed some screen shots and speculated about common themes. Graham Wright was not able to attend & his place was taken by South African representatives talking about their experiences. The use of ICT is increasing but there is no formal recognition of the role and there is a lack of appropriate education at various levels. Much of healthcare in sub Saharan Africa is nurse led and delivered and is competing for resources.

The next session I attended was exploring organisational issues. The first paper was about the MEDAL project measuring emergency department’s adaptive load in an Israeli hospital. He described waiting times and overcrowding in ED as being a major problem and the development of a tool to try to identify the best use of resources, highlighting where the major bottlenecks occur. Current approaches use statistical calculations to produce load factors, however this project argued there is no average and the issues for nurses, doctors & patients are different and any system needed to take into account the “gut feelings” of the people involved, based on a neural network approach. Their new system enables staff to disagree with the score and update the weights by clicking a button on the workload dashboard. Alarm can be set to trigger local problems.

The next paper was “Theories. Models and frameworks for diagnosing technology induced errors” presented by Andre Kushniruka. It started with definitions and examples of medication and other unintended consequences and reported on a systematic review of papers in the field. At the lowest level software engineering and programming problems, working up to human factors and ultimately organisational approaches. Examples of the application of the models were given followed by discussion of certification of technology and processes and tracking adverse events. A good and interesting presentation. e-iatrogensis seems be an emerging and important growth area!

The next paper, by Charles Webster, looked at process aware EHR BPM systems – two prototypes and a conceptual framework. The Business Process Management models and diagrams were very busy and seemed to see cost and efficiency as being the ultimate goals. I lost the plot around the “patient class event hierarchy” and “closed loop process improvement” and diagrams and language which didn’t help to explain anything to me. “Process mining” might be the way to go – but after this talk I have less idea than I did at the start.

The next paper with two speakers (“to prevent it being deadly boring” ;-) looking at virtual autopsies in forensic science in Sweden. The technology examines cold human bodies to determine cause of death, using MRI & CT. The virtual autopsy table is available on You Tube. From the look of the video this is the ultimate coffee table!! This paper focused on the real introduction of the technology into real world workflow environments, not just for the police and forensic science services but also to prevent the information in court. (see http://www.visualiseringcenter.se and soon at www.aprigroup.se

The final paper of the morning, by Mirjam Ekstedt and colleagues from Oslo, Norway, asked why people want a paper copy of their Electronic Patient Record (EPR)? Patients n ow have the right to see their records, but few actually do this. The study looked at why people want to see the records and any conflicts between confidentiality, trust and control with a focus on the transmission of one’s own information. The risks of delay, information overload because of poorly organised records and lower quality discharge summaries were considered. A summary care record was seen as a way forward, however the value of this was challenged during the Q&A session.

After lunch I attended a panel session entitled “The need to develop Health Informatics to become an Evidence-based Health Science, and the Role of the Global ACE (alliance for clinical excellence) Initiative.” The chair and 1st speaker was Michael Rigby from the UK, followed by Jan Talmon from the Netherlands and finally Mehdi Khaled from Oracle. They have been working on evaluation guideline for health informatics. Michael suggested that many health informatics implementations had received an “easy ride” in scientific terms and that this has been abused by policy makers. He started with some frequently made assumptions highlighting some of the risks when the assumptions are not challenged. He followed this with some “facts” about problems in health informatics which may have made uncomfortable reading for many advocates. He suggested that any other change in medicine/healthcare requires evidence to support it but major changes brought by health information systems don’t need the same level of evidence.

Jan Talmon moved on to examine evidence and evaluation. The complexity of the human factors in healthcare make the generation of methodologically robust studies more difficult. Changes to the EU directive earlier this year to include software as medical devices may require much more detailed evaluation before it becomes licensed. The declaration of Innsbruck provides guidelines for evaluation systems. See GEP-HI & STARE-HI.

Mehdi Khaled started with a historical story about a trail showing the role of citrus fruit in scurvy in 1747, and then went on to look at recent evaluation projects on CPOE and other systems. The conclusion was around the need for standardised evaluation tools contained within the Global alliance for Clinical Excellence – a not for profit company, which is currently looking for partners. An interesting discussion about the potential benefits (and some of the hurdles) tried to explore where this sort of approach may be going.

Final sessionThe final session was a plenary session with the awards. Chaired by Enrico Coiera it included a final report by Reinhold Haux as the outgoing president and the handover to Antoine Geissbuhler the incoming president. The Scientific Programme Committee awarded prizes for the best posters and papers and IMIA awards for excellence were presented. There were also thanks to the many many people who have been instrumental in putting the conference together and the ceremony concluded with a presentation by the winning bid team who will be running the next Medinfo in 2013 in Copenhagen.

Final thoughts.

At the end of a major conference like this it is useful to reflect on all aspects from the scientific papers, panels and demonstrations to the venue, organisation, catering etcCape Town is a nice friendly city, and makes a good base for tourism – although the weather was changeable with the initial days sunny but by Wednesday becoming grey and damp. The venue itself was adequate although the provision of the wireless network and power outlets was poor and the requirement to have a ticket to get a cup of coffee was over the top. There appeared to less exhibitors than at previous events. I didn’t get a chance to see many of the posters as these were only up for a short period of time while the “tours” were going on and when then removed – they could have been left up for longer so that others who were not able to attend the tour could see them – there was certainly enough space in the hall. It was good to meet up with many old friends and meet new ones – and often the informal and social networking is one of the real benefits of this sort of event.As often occurs with these meetings, the programme tried together related topics, however this sometimes meant that 3 or 4 presentations which were of interest occurred simultaneously and then the next couple of hours had little of direct interest. Because of the meeting being in Africa there has, rightly, been a focus on the developing world , which has given it a different flavour. Some of the work was very practical and others on a more esoteric theoretical levels. There were some good papers and one or two really innovative ideas but many were not that inspiring – both in terms of the content and the quality of presentations.On the selection of presentations I was able to attend I did not feel that health informatics has moved on very much over the last 3 years and I didn’t really get a feel for where the work may be going over the next few years – possibly apart from the growth in the study of e-iatrogenesis and/or telecare/remote monitoring. I now have a few hours to explore Cape Town and hopefully Table Mountain before getting back to the airport for my flight back to the UK.

Tuesday, September 14, 2010

Medinfo Day 2

I was a bit late this morning following a good conversation at breakfast about the health services in South Africa and then a search for new batteries for my camera (the first thing I've found here which seemed expensive), managed to attend one of the two semi-plenaries running first thing. The subject is ehealth for the developing world, particularly Africa. Various speakers gave insights into the challenges faced and some current and potential improvements (simple, cheap, solar powered & mobile devices + standards etc) with examples from Rwanda, Mozambique, Kenya, Malawi, Tanzania, South Africa etc. Particular challenges around HIV, malaria provide threats which need to be met by local ownership and development, rather than solutions from developed countries/donors.

The second session I attended had an education and training flavour. Niki Shaw from British Columbia presented a study about the effects of the EMR on primary care consultations in a large number of practices in British Columbia, Canada. She set the context and some of the difficulties involved in undertaking the work and then described how many clinicians said using the computer would interfere with patient interaction, however her team found that, in common with the paper record, most GPs didn't actually do charting until after the patient had left the room. She then talked about the lack of any health informatics education in medical courses, and suggested ways in which this could be achieved, along with recommendations for further research into the effect of real time charting on the patient interaction. The second speaker was Thomas Houston from the USA who described work using content specific email reminders to dentists to get them to encourage their patients to use a smoking cessation online resource. There finding showed the first part of the week was the best to get a response to emails and the importance of making the headlines (message subject lines) relevant to the target audience. The final speaker I saw was Bernhard Briel from Munster University who described the development of a shared module for medical and information science students who worked together developing case examples related to health informatics. He emphasised the importance and benefits to be obtained from cross disciplinary learning.

After lunch I attended a session within the theme on Social Networking and Virtual Reality. The chair, Walter Slack, introduced the session by considering virtual reality – going back to cave paintings as ways to enhance social networking. He suggested that if used well it has the capability to enhance nursing and healthcare. The first paper was by Annie Lau presenting the influence of crowds on consumer health decisions. She started with an adaptation of an experiment, with planted volunteers giving a wrong answer & then seeing if the rest of the room followed (they didn’t) as an introduction to their online prospective study to test the strength of social relationships on behaviour. An overview of some of the existing theories relating to social attachment etc was given to put more recent online work into the context of existing studies in face to face settings, including conversion theory and subjective consensus. The measures developed were opinion volume and opinion density. The study used 227 undergraduates to measure their health knowledge, then search for more information and then see what others had said and measured their responses at each point. Those who were not confident of their answer after their search were likely to change their answers after seeing the responses of others – this effect was strongest if more than 15 other people had answered the question differently to them. The more people who gave a different answer the more likely each individual was to change it. The presentation of the statistics was not particularly helpful but the discussion and presentation was one of the best I have seen at the conference so far. There was some discussion in the room, around the significance of the findings on health behaviours, but no one knew of any studies which had examined whether the number of friends on Facebook etc was a significant factor on the value which was placed on their opinion.

The next speaker was Elizabeth (Betsy) Weiner from Vanderbilt University who spoke about the use of the Virtual Reality World of Second life to Teach Nursing Faculty Simulation Management. She described her history in simulation development since interactive video disks. She described her institutions grant and overview of Second Life. Faculty staff needed development in simulation management and second life navigation and interaction. NURSIM4U Island includes a conference centre and 12 simulations (in one of several settings) meeting the “Hartford Geriatric Competencies”. They have an outpatient department, a critical care tower, a nursing home, with observation rooms behind a one way mirror to stop rooms getting crowded. Each iof the 12 cases has an electronic health records derived from anonymised real records. Tools for evaluation are from the NLN Laererdal Study. She discussed the scripting of simulations.

The third speaker was Trish Trangenstein talking about an analysis of Nursing Education’s immersion into second life. She argued for advantages of the MUVE in immersion and activity. Used searches in SL, Google, pubmed etc to find nursing education activities. Few nurse education simulations were found. A template was proposed to enable sharing & collaboration. A question about empirical research didn’t get much response apart from evaluation tools. The use of SL for patient therapeutic experiences was also discussed.

The final session I attended before escaping to get back to the hotel to change for the Gala Dinner was entitled Advances in Medical Informatics and looked at several cutting edge advances. The paper I was particularly interested in was by Gunter Eysenbach describing his 10 years experie4nce with pioneering open access publishing in health informatics: The Journal of Medical Internet Research. He started out by highlighting knowledge transfer problems as a major barrier to healthcare development and found it ironic that health informaticians who deal with knowledge management... yet we are not generally not good at doing a good job in knowledge translation. He touched on different definitions of open access and compared it with self archiving in institutional repositories. He described 7 publishing innovations, including article level metrics, an Open Source manuscript management system from the XML version of the paper, WebCite and an innovative business model. Another new experiment is open peer review and he is working on a new development where papers are put in a moderated collection which others can then comment on before formal publication which will be called the interactive Journal of Medical Research - iJMR on Knol.

Monday, September 13, 2010

Medinfo Day 1

Monday morning commenced with two key note presentations. The first, by Marion Ball provided a history lesson and then identified some current issues (many largely unchanged from 30 years ago)including "e-iatrogensis" focusing on administration errors and other issues caused by computer systems. She moved on to look into the future and highlighting the importance of process re-engineering with emphasis on human factors - including a comparison of the workings of a formula 1 pit team and an operating theatre. She also looked forward to the effects of genomic medicine.

The second keynote was by Reinhold Haux as outgoing IMIA president. He also looked at the past present and future of medical informatics. He highlighted the importance of work in the field already undertaken as being highly original and relevant. He then moved on to the future - providing two scenarios a conservative view and a more radical or progressive alternative of the paths we may be travelling down in the next few years.

From this point on there were at least 10 events happening simultaneously, so I can only report on the bits I attended. For the first one I didn't have any choice as I was presenting my critique of the Technology Acceptance and Diffusion of Innovation models. This was followed by a speaker exploring the process undertaken in the selection of a technology for a group of hospitals but then devolve implementation to local hospitals. She highlighted issues of communication and work flow analysis. The next speaker was Rhima Padman who had studied an online consultation system known as eVisit. Another US speaker Nancy Lorenzi described a case study on the development of evidence based medicine work. The final speaker in the session was from Denmark and reported a study looking at the involvement of physicians in the selection of an EHR system, highlighting the power of the IT department and administrators over clinicians.

After lunch I attended a panel discussion related to Social media tools for personal health and well-being. The first speaker was from Finland who described the creation and use of an environment similar to Facebook, and a study undertaken to look at how new mothers used the system. They found it useful to use the environment to share ideas, photos etc but didn't have the time to do blogs etc. The next speaker was Kaija Saranto who looked at 6 basic ethical principles when using social interaction sites. She was followed by Ann Moen from the University of Oslo, discussing work to develop an environment for shared collaborative knowledge generation, which presents health information about particular rare conditions to patients with comments and discussion - and some of the issues which have arisen. The next speaker was Peter Murray (now CEO of IMIA) who took a different tack looking at "a survivors guide to Web 2.0 in health informatics". He gave various thanks & plugs for people & events including the New IMIA Social Media working group. He talked about the tools and risks to personal information. He look at the time involved in various applications, and moved on to their use and how we research them. Not only did he talk about how health professionals and their organisations use social media tools - but also how patients are using them. Peter was followed by Margaret Hansen who gave examples of using social media for healthcare informatics students, including wikieducator, social bookmarking, and using an ipad to tweet about self care. The short presentations were then followed by comments and questions, which kicked off with issues about information quality and professional responsibility to provide or challenge the information. Further discussion related to gate keepers and apomediation.

The next session included papers on user centered design and participatory interactive design with particular emphasis on getting both experts and end users involved in all stages of system and user interface design.

My final session at the end of a long day was a workshop on social media lead by Dr Bob - not all areas which were intended eg a second screen and twitter feed were not possible but several speakers outlined experiences, and ethical debates from professional and patient perspectives on social media, and how these might meet under served populations. The final presentation called for research and the creation of guidelines for patients using social media sites, which promoted a lively discussion session.

Sunday, September 12, 2010

Cape Town for Medinfo

Travel to get here, via a national express Coach to Heathrow and then a British Airways overnight flight was long but not too much hassle. Being asked to step into the full body scanner after I had passed through security was a new experience, but I couldn’t see the image which was taken – perhaps thankfully – otherwise I might have shared it here as an example on innovative protective/intrusive technologies!I met a few people also travelling to medinfo at the airport while waiting for the transfer bus & then had a tour of the city while people were dropped at various hotels. A colleague at work (thanks Leigh) had booked me into the Protea Breakwater Lodge Hotel, one of the cheapest in the area, which, is part of and integrated with the Graduate Business School of the University of Cape Town and has an interesting history having previously served as a prison for convicts working on the construction of the breakwater for the early harbour in the 1850s and 60s. The current buildings include the industrial breakwater prison which was built in 1901, later serving juvenile offenders and then, until 1989, as a hostel for black dock workers.

My room wasn’t ready for a morning arrival so I dumped my bags and went for a warm and sunny wander around the Victoria and Alfred Waterfront, which is just over the road from the hotel. This is a revamped part of the docks which has been developed as a shopping and cultural centre, with a variety of attractions, bars, cafes and restaurants, while preserving some of the interesting industrial and cultural buildings. It is quite reminiscent of the new developments at Bristol’s floating harbour. Back at the hotel I got into my room and grabbed a much needed shower and then went back to the waterfront to catch a ferry to Robben Island Museum This world heritage site has become famous since the release of nelson Mandela and the tour provides a guided coach ride around the island stopping at historic sites before a walk around the prison buildings, including Mandela’s cell led by one of the ex political prisoners. I hadn’t slept much on the plane and by this point and by this point I was exhausted so I had a meal at the hotel and went to bed.

After breakfast this morning I went for a walk/scramble up and around Signal Hill, so called because the noon gun is still fired from it, and got some good photos of Cape Town. The walk included seeing some birds, plants and butterflies I’d never seen before and conversations/directions from some of Cape Town’s down and outs that seem to congregate there. It provides impressive views over Cape Town. I then walked down the hill to Sea Point and Three Anchor Bay before strolling, passed the Cape Town Stadium, back to the hotel to get ready for the walk to the conference centre for the opening of the conference.

The registration process worked quite well with appropriate name badges etc & then picking up a conference bag with the proceedings etc. After a quick scan of the programme I found the speakers to to upload my presentation & asked the technician for the password for the event wifi system. A quick wander around the large building & a chat with a few other delegates has identified major problems with the wifi signal not reaching the whole building & the signal dropping on a regular basis - this doesn't bode well for the next few days when there will be hundreds of people trying to access it at the same time. The medinfo technicians have reported this to the CTICC staff & hopefully it will get better.

The opening ceremony began with the South African Youth Choir singing SA National Anthem - Nkosi Sikelel' iAfrika. This was followed by Lyn Hammer (the chair of the local organising committee) who introduced Reinhold Haux (The outgoing president of IMIA) who gave an overview of IMIA and thanked various people who had been involved in the organisation of the conference. He also presented Honorary Fellowship of IMIA to Sedick Isaacs.

The road for the Medinfo conference to Cape town was set out with an introduction to the key theme of partnerships with a special emphasis on Africa, which has been adopted for the event. The cochairs of the scientific programme committee described the large number of submissions of papers, posters, panels etc for the and how they had been selected and then Charles Safran described the procedures in producing the proceedings.

The first keynote was given by Dr Najeeb Al-Shorbaji from the World Health organisation, who gave an overview of many of the existing health challenges particularly in developing countries and focused on the role of ICT and ehealth in achieving the Millennium Development Goals (MDGs).

The second keynote was given by the South African government health minister who outlined the priorities highlighted within the country. The closing event of the opening ceremony was a concert by the South African Youth Orchestra, who were obviously enjoying their presentation which also went down well with the audience.An informal reception with wine and various meals followed which provided and opportunity to meet up with old friends and make some new ones amongst the delegates.

About

Eclectic news and views on health informatics and elearning, by Rod Ward & colleagues. UK bias but worldwide coverage.
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